Organization
LOGAN PHYSICIAN PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (VP, CORPORATE SECRETARY)
(629) 253-5121
Entity
Organization
Contact information
Practice address
975 HOPKINSVILLE RD, RUSSELLVILLE, KY 42276-9792
(270) 726-2738
Mailing address
113 SEABOARD LN STE 201B, FRANKLIN, TN 37067-8284
(629) 253-5121
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65935777
—
KY
Enumeration date
07/09/2006
Last updated
04/13/2023
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